Nutrition-Related Outcome in Critical Care

The practical limitations of conducting clinical studies in critical care patients have impacted the ability of sponsoring agencies to demonstrate convincing outcome improvements from appropriate and aggressive nutrition support. Clinical nutrition research seems to suffer from the same problems that have been identified and described by Berg [1] for the field of general nutrition; these problems include emphasis on the wrong research issues and a negligence in preparing individuals to work operationally in nutrition. Interpretation of the clinical nutrition literature is confounded by improperly designed and under-powered studies from which conclusions, which are frequently not supported by the data described, are drawn. In diligent attempts to dissect the mechanisms of energy utilization, to determine specific nutrient requirements, and to compare product formulations and routes of administration, the clinical nutrition community may have done a disservice to other health care providers, as well as patients. This approach may have obscured evidence suggesting that nutrient and energy balance improve outcome. Point-counter-point arguments of feeding versus no feeding and debates over the merits of one type of nutrition support versus another, while academically challenging, are not the most instructive from which to build a solid body of literature supporting the use of nutrition support. These types of arguments are not convincing to third-party payers, managed care providers, or practicing physicians who are unaccustomed to considering nutrition relevant to their medical practice.